Will the Brain Gain from the Diaspora Revive the Health Sector?

“Daddy, you know this would never have happened when you were working in Lincoln, right?” Dr. Olujimi Coker, Medical Director of Lagoon Hospitals, Lagos was telling an enthusiastic audience of 400 people at the Sheraton Hotel, Abuja, how his awestruck children reacted to his cancelling a family weekend trip, because he had been asked to be on standby in Lagos as a renowned global political personality was visiting Lagos and he might be needed in a medical emergency.

This was one of the positive experiences of his move back that Dr Coker, who returned to Nigeria in 2009 after 20 years as a surgeon in the UK NHS shared at the Future of Health Conference 2018 last Thursday. On challenges, he cited concerns around poor quality and the ability to continue to deliver high standards of care as key issues facing healthcare professionals abroad wishing to return to work in Nigeria. Emphasizing the need for tertiary hospitals in Nigeria to rise to the challenge of improving their standards of care, he identified family support as essential for any planned move back as making the transition back to Nigeria is never easy.

Despite the many challenges, Dr Coker and the other 10 speakers at the conference, which had the theme “The Diaspora as Nigeria’s Brain Gain,” agreed that there is a need for many of the Nigerian health professionals abroad to come back, mentioning several opportunities and benefits for Nigerian health workers who take the step to return. Dr. Ukwori-Gisela Kalu, a consultant clinical psychologist, who returned from the UK a few years ago talked about the great unmet need and the many opportunities to make a difference in mental health in Nigeria. Testifying to the incomparable satisfaction that she derived from her work in Nigeria, she mentioned opportunities to use technology to provide therapy online, and using mass media to raise awareness about mental health concerns as two things that excited her.

The Future of Health Conference organized by Nigeria Health Watch and partners is rapidly acquiring a reputation as Nigeria’s premier conference that brings to the fore critical health issues which affect the entire health sector. Since 2015, the Conference has brought together key stakeholders in the health sector to share their insights, knowledge and expertise to foster collaborations that will improve health and advance healthcare access and delivery in Nigeria.

This year, the focus was on the many Nigerian healthcare professionals in the diaspora and highlighting how over the last decade, many are bringing their skills, experiences and resources back home to improve Nigeria’s health sector. The conference also explored ways in which government and other partners can help create a better ecosystem for those wishing to return. Speakers at the conference shared a variety of experiences, some had returned fully, others visited periodically and regularly. They shared the challenges they faced upon returning as well as opportunities in their fields of practice, sharing valuable advice for others interested in returning.

For Dr. Chummy Nwogu, CEO of Lakeshore Cancer Centre Lagos, despite challenges like corruption, high interest rates and bureaucratic bottlenecks, coming back to Nigeria is all about inspiring the next generation of professionals. He advised intending returnees to ensure that they aligned their ‘head, heart and pocket’ when planning their return. Dr. Fatima Kyari, Founder of the Centre for Community and Rural Eye care, said her stay outside the country opened her eyes to how passion, integrity and information are critical for healthcare delivery. Describing her experience visiting over 300 hospitals across the country while working on a national survey, she lamented that 4 out of every 5 cases of blindness in Nigeria are preventable.

A hostile business environment and the absence of a favourable ecosystem to support a start-up healthcare practice were some of several challenges Dr. Atinuke Uwajeh, co-founder of Paediatric Partners Hospital, faced when she cashed in her retirement savings and left her private practice in the US to relocate to Nigeria. Other challenges were the high cost of power and the prevalence of substandard medications. Even after setting up, attracting patients was difficult because of the Medical and Dental Council of Nigeria rules on medical advertisements. Dr. Uwajeh said she used social media like WhatsApp to network and create a market for her practice. “Returning to Nigeria requires a lot of planning and determination, but the Nigerian patient is worth it”, she said.

Businesses need capital, and the business of healthcare is no different. Dr. Olumide Okunola, healthcare program manager of the International Finance Corporation (IFC) at the World Bank, believes that the cost of capital for healthcare investments should not be unnecessarily high. He noted in his talk that India has been able to provide a concession model for healthcare, providing access to poor and vulnerable people, suggesting that Nigeria can emulate that model. He advised returnees to take advantage of the state health insurance schemes operating in 16 states across the country, and tap into various loan schemes of the Federal Government.

One of the many advantages of practicing in the diaspora is the opportunity to build networks, which can continue to support your practice when you return, according to Dr. Zainab Bagudu, CEO of Medicaid Foundation. She recalled how, upon returning to Nigeria after her studies in the UK, applying the lessons she had learned abroad, she worked hard to establish and maintain relationships with her paediatric patients and their parents. This, she said, helped her build trust, a practice that distinguished her from some of her colleagues. Mr. Temitayo Erogbogbo, who is based in Switzerland but visits often in his role as Director of Advocacy, MSD for Mothers said that maternal health should be made a priority in Nigeria as women contribute significantly to the GDP of the country. He revealed that contraceptive use in Nigeria is at 10%. For him, maternal mortality is an emergency that must be engaged and argued that everyone, including the private sector, has a part to play.

For consultant neurosurgeon, Mr. Douglas Emeka Okor, a massive gap in expertise in neurosurgery during his time in medical school in Benin, influenced his decision to be a brain surgeon. He said that Nigeria needs grit and passion to make the desired gains in the health sector possible and when these gains are achieved, they can be maintained through, cultural integration, quality of life of patients, availability of innovative information and Public-Private Partnerships (PPP). He also emphasized that most Nigerians do not know that many of the conditions that they go abroad to treat can now be treated successfully at high quality in Nigeria.

Dr. Olufemi Sunmonu, co-founder/director, PurpleSource HealthCare, advised health professionals who are planning to return to come back with an open mind, take the time to find out what is happening on the ground, explore the unknowns as if they were children and begin with asking very basic questions and listen and learn. He advised returning health professionals to focus on interventions that are within their skills and expertise to help them focus and perform optimally.

Highlighting the level of need in the Nigerian health sector, Prof. Rotimi Jaiyesimi, Secretary, Medical Association of Nigerians Across Great Britain (MANSAG), revealed that there is only 1 doctor to about 60,000 patients in Nigeria. He said that 70% of the diseases in Nigeria can be treated at the primary care level therefore focus should be on the primary health care system in Nigeria. For him, patriotism, passion and patience are the three most important qualities any intending returnee should have.

A panel discussion followed each session and provided an avenue for the audience to interact with the speakers. The first panel discussion highlighted volunteering in medical outreach missions across the country as a way for diaspora professionals to test the waters and get acquainted with the healthcare community back home. The session also discussed the need for greater government engagement with the medical missions being carried out by various NGOs, and the importance of collaboration and mutual respect among healthcare professionals. The second panel discussion revolved around how to sustain and expand gains that have been made from the skills. The panel also talked about how creating a system that prevents disease is more sustainable in the long run, with Dr. Bagudu using her cancer awareness campaign and advocacy as an example.

The consensus among participants was that government should take the lead in providing an enabling environment to encourage more diaspora participation in Nigeria’s health sector. Senior Special Assistant to the President on Diaspora Affairs, Hon. Abike Dabiri-Barewa, represented by Dr. Badewa Williams, affirmed that the expertise of Nigerians in the diaspora is very important. She announced plans by the government to hold a diaspora summit between the 27th and 29th of November with the sole aim of encouraging Nigerian professionals in the diaspora to return home and invest in the country. The Nigeria Medical Association (NMA) represented by Dr. Tonnie Okoye, National Strategic Program Manager, announced efforts by the NMA to create an electronic directory that will connect various medical professionals with each other anywhere in the world to facilitate knowledge transfer.

Nigeria Health Watch Co-Founder and Curator, Dr. Ike Anya noted that the problems of the Nigerian health system are well known, so greater focus should be placed on solutions to change the status quo. “The Nigerian health system is not where it should be but also, it is not where it used to be decades ago. It can only improve when there is sincerity of purpose and collaboration by people who are passionate to see that Nigerian patients live their lives to the fullest,” he said.

The #BrainGain4Naija conference on the 18th of October was followed by a workshop on the role of financing healthcare investments in Nigeria on October 19, hosted by Nigeria Health Watch in partnership with the International Finance Corporation of the World Bank. The workshop brought together experts in health financing and investments and healthcare professionals to explore the many opportunities for health financing and funding for healthcare businesses in Nigeria. Nigeria Health Watch will publish a detailed report on the workshop.

The #BrainGain4Naija Conference saw over 300 participants in attendance with live audiences on Facebook and YouTube. Despite the huge challenges that come with practicing and investing in healthcare in Nigeria, there was a consensus that the opportunities which exist for returnees are numerous and that it is time for everyone to leverage on the brain-gain momentum.

Diaspora health professionals should bring in their specialist skills, advanced training and networks while home-grown health professionals should provide context and guidance. However, the brain-gain must be sustained by a responsible government, providing an enabling environment for these collaborations to thrive. We must all contribute our quota to make the health sector work…because, as more than one speaker emphasized, the Nigerian patient is worth it.

As part of the conference, Nigeria Health Watch produced the first edition of a directory of innovative health services now available in Nigeria. The directory will be available online and new services will be added to it as they come to our attention. In addition, as with all of our previous Future of Health conferences, the speaker presentations and panel discussions will be available on our YouTube channel to serve as a resource for those contemplating a move back.

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